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- CONSULTANT E.N.T., Primary Health Care Corporation [ P.H.C.C.] Govt. Of Qatar
*Corresponding author:
Acharya. D, CONSULTANT E.N.T., Primary Health Care Corporation [ P.H.C.C.] Govt. Of Qatar
Received:September 25, 2019; Published: October 09, 2019
DOI: 10.32474/SJO.2019.01.000157
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Abstract
Statement of The Problem
This provides an overview of Allergic Rhinitis and its management. It is very useful for students of Rhinology and clinicians
managing this disease. It introduces them to a systematic approach of assessing allergic rhinitis patients which is very commonly
found in most populations and causes considerably morbidity. Allergy per se is a very difficult subject to master and it is with great
perseverance one can treat patients suffering from this condition. The cornerstone of managing a patient of allergic rhinitis is first
and foremost obtaining a good history. This is to be followed by a thorough examination and investigations. The general practitioner
is the first expert to be involved in management of allergic rhinitis patient followed by specialists otorhinolaryngologists, and finally
by allied healthcare personnel. Inflammation of nose and paranasal sinuses are characterized by two or more symptoms-namely,
either nasal blockage; obstruction; congestion or nasal discharge. Associated symptoms include facial pain; pressure and either
reduction or loss of smell. Certain diagnostic endoscopic signs of nasal polyps and or mucopurulent discharge and or mucosal
oedema in the middle meatus and or CT changes of mucosa within the ostoemeatal complex, and or sinuses are seen. Definitions,
aetiologies, clinical presentations, diagnosis; prognosis and management of allergic rhinitis is dealt with. Common allergens causing
the disease are mentioned, pathophysiology and classification of allergic rhinitis is discussed in detail. Different types of allergen
testing are highlighted along with their specific role and uniqueness. Principles of immunotherapy in treatment of allergic rhinitis
are discussed here. Health effects of allergic rhinitis along with its impact on physical quality of life is mentioned. The basic idea
of this presentation is to improve diagnostic accuracy by promoting appropriate use of ancillary tests like nasoendoscopy, allergy
testing, computed tomography etc. and reduce inappropriate antibiotic use. The basic treatment plan of allergic rhinitis is according
to the severity and duration. It consists of allergen avoidance, pharmacotherapy, allergen immunotherapy and surgery which has
limited role.
Keywords: Allergy; Rhinitis; Pollens; Molds; Insects; Penicillium; Cladosporium; Hypersensitivity; Histamine; Hay fever; Rose
Fever; Transverse Nasal Crease; Rhinorrhea; Allergic Salute; Allergic Shiners (Dennie -Morgan Lines); Cobblestone Appearance
Of Oropharynx; Scratch Test ; Intradermal Test; Patch Test; Rhinomanometry; Antihistaminics; Immunotherapy; Topical Nasal
Steroids; Cochrane; Mast Cell Stabilizer
Abbreviations: IgA: Immunoglobulin A, IgE: Immunoglobulin E, AR: Allergic Rhinitis; NAR: Non-Allergic Rhinitis; ARIA:
Allergic Rhinitis & its Impact on Asthma; Greater than; Less than; TM: Tympanic membrane; NPT: Nasal Provocation Test; n NO:
Nitrogen in Nitric Oxide; PNS: Para Nasal Sinuses; OM: Occipito Mental; CECT: Contrast Enhanced Computerized Scan; L.A: Local
Anaesthesia GA: General Anaesthesia; PQLI: Physical Quality of Life Index; WAO: World Allergy Organization; SCIT: Subcutaneous
immunotherapy; SLIT: Sublingual immunotherapy; AIT: Allergic Immunotherapy; e-Health: Electronic Health; DBPC: Double Blind
Placebo Controlled; RCT: Randomized Controlled Trial; FDA: Food & Drug Administration federal agency in USA; SMD: Submucous
Diathermy; IT: Inferior turbinate; FESS: Functional Endoscopic Sinus Surgery; OMC: Osteo Meatal Complex
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Pharmacotherapy
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